<h3>Profile Autofill</h3>
<form name="addr1.1" id="form1" action="https://example.com" method="post">
  Name: <input type="text" name="name"><br>
  Line 1: <input type="text" name="addressLineOne"><br>
  Line 2: <input type="text" name="addressLineTwo"><br>
  City: <input type="text" name="city"><br>
  State: <select name="state">
    <option value="CA">CA</option>
    <option value="MA">MA</option>
    <option value="NY">NY</option>
    <option value="MD">MD</option>
    <option value="OR">OR</option>
    <option value="OH">OH</option>
    <option value="IL">IL</option>
    <option value="DC">DC</option>
    <option value="QC">QC</option>
  </select> <br>
  Zip: <input name="zip" id="form_zip"> <br>
  Email: <input name="email" id="form_email"> <br>
  <input type="reset" value="Reset">
  <input type="submit" value="Submit">
</form>
